Experts are urging caution as Americans huddle indoors during the late fall and winter months, with COVID-19 cases already on the rise ahead of the Thanksgiving holiday.
Now that most people in the US have contracted COVID-19 at least once, there can be some complacency; but while another round of SARS-CoV-2 infection may be starting to feel like old hat, experts warn that the possibility of long-term COVID is still a threat Americans should be wary of — even if they’ve managed to avoid a long one in the past COVID.
What is long COVID?
There is no single agreed-upon definition of prolonged COVID, nor any agreed-upon method for defining and diagnosing it.
The Centers for Disease Control and Prevention reported in June that nearly 1 in 5 Americans who had COVID-19 still have symptoms of prolonged COVID, which the CDC defines as symptoms lasting more than three months after infection that were not previously present. Long-term COVID symptoms vary—from respiratory and cardiac symptoms to neurological symptoms to general ailments like fatigue or muscle aches—and the CDC says that while long-term COVID is more common in people who have had a severe bout of COVID-19, even people who have had mild or asymptomatic cases may suffer from “post-COVID conditions”.
Dr. Luis Ostrosky-Zeichner, chief of infectious diseases at UTHealth Houston and Memorial Hermann Hospital, said he sees three types of patients at the hospital’s long-term COVID clinic: people with persistent damage from a severe case of COVID-19; people with underlying illnesses that have been made worse by COVID-19; and “what we consider to be ‘true’ long-term COVID patients who have multiple symptoms for which we cannot currently find an objective cause.”
Ostrosky said the good news is that most patients in the last category of long-term COVID patients get better on their own within four to six months.
“But some patients we follow for a year or a year and a half have not recovered. And that’s where we need more research into therapeutic options for them,” he said.
What happens if you’ve had COVID for a long time and you get COVID-19 again?
For those who have been battling COVID for a long time, Ostrosky said getting another infection can be a huge blow.
“It’s pretty devastating,” Ostrosky said of some of the patients he’s seen with long-term COVID who have been reinfected with SARS-CoV-2. “Maybe they’ve made a lot of progress in that four- to six-month recovery process, and then it’s a huge setback for them. Very demoralizing, very depressing for them when that happens.”
More research is still needed on how reinfection affects those already suffering from long-term COVID illness, but some cases may provide some insight. In a recent online survey conducted in the UK, 80% of those who described themselves as having persistent COVID symptoms said that another case of COVID-19 had made their symptoms worse.
Of those in recovery or remission from long-term COVID, reinfection recurred in about 60% of individuals; of these individuals, 40% reported that the second bout of prolonged COVID was as severe as the first, 32% reported that it was less severe, and 28% reported that it was more severe.
“It’s a pretty wide range of experience when it comes to the severity of a second bout of prolonged COVID,” Dr. Jessica Justman, an associate professor of epidemiology at Columbia University, who did not participate in the survey. “Bottom line: If you have or have had long COVID, getting infected again can cause your long COVID to get worse or come back. So it’s another reason to get vaccinated and take steps to minimize exposure.”
If you haven’t had COVID for a long time before, how might a second (or third or fourth) infection with COVID-19 affect your chances of developing it?
The CDC says that symptoms from reinfection are likely to be less severe than the first infection, but that “some people may experience more severe COVID-19 during reinfection” and that the assortment of circulating variants may mean that an individual may not have as much immunity from a previous infection as is usually the case it happens.
So even if you didn’t get long COVID the first time, it’s still possible to develop long COVID if you get the virus again.
“Past performance does not predict future performance. Maybe you’ve already had a really mild case, but you’re not sure if the next case will be just as mild or more serious,” Ostroský said.
“Also, we don’t know that much about what kind of damage accumulates with repeated infections.” So don’t let your guard down.”
A study released last week using data from the Department of Veterans Affairs’ National Health Care Database found that reinfection increases the risk of long-term COVID as well as other adverse health outcomes, including a two-fold increased risk of death and a three-fold increased risk of hospitalization. compared to those who were not reinfected.
“Unambiguously, our research has shown that getting infected a second, third or fourth time contributes to additional health risks in the acute phase, meaning the first 30 days after infection, and in the following months, meaning the long phase of COVID,” Senior Author Ziyad Al-Aly stated in a press release.
The study found that reinfection increased the risks of long-term COVID regardless of whether participants were unvaccinated, vaccinated or boosted. However, in general, the impact of vaccination status on long-term outcomes of COVID is still unclear. Another study by the same authors found that those who received the COVID vaccine were only 15% less likely to develop long-term COVID than those who were not vaccinated, but the CDC says that people who are not vaccinated may be at a higher risk of developing -COVID” than those who are vaccinated. Other studies have shown that those who received two doses of the COVID vaccine cut their risk of developing long-term COVID in half.
“For people who feel like, ‘I’m not going to die from COVID, it’s okay to get multiple infections,’ this should be a really open study that shows us there’s still a lot to learn about the long-term consequences. several episodes of this infection,” Ostrosky said.
Justman pointed out that while the study provides additional reasons to pay close attention to vaccinations and stay informed, the retrospective nature of the study means some results may have been missed. Because participant data were collected retrospectively rather than followed in real time, the study may have missed some participants who were reinfected with SARS-CoV-2 but were asymptomatic, or who tested positive for a mild case and did not seek treatment . . If such cases were properly counted, Justman said, it could reduce the risks posed by reinfection.
“Saw [what’s known as] dose-response relationship,” Justman said. “Individuals who had three COVID infections had a higher risk of these outcomes than people who had two infections, and those with two infections had a higher risk than people who had only one. And whenever you see that kind of dose-response relationship, it tells you that what you’re looking at might be real.”
What happens next?
While information about prolonged COVID and reinfection—and prolonged COVID in general—is limited, a number of studies are underway that may soon offer some answers. The National Institutes of Health is working on a study called Researching COVID to Enhance Recovery (RECOVER) to learn more about the long-term effects of COVID-19. The CDC is also conducting a number of studies with partners, including Nova Southeastern University for a project called “COVID-19: Understanding the Postviral Phase (COVID-UPP)” on patients who have had symptoms for more than three months. after infection.
“There’s going to be a lot of information coming out, so it’s kind of like, ‘Watch this space,'” Justman said. “It’s definitely a work in progress, but I think what we’ve learned so far would reinforce the same messages that everyone in public health keeps repeating — which it seems like the public might not want to hear anymore. It’s still important to get all the vaccines you can possibly get [yourself] flu vaccine, COVID boosters. And if you’re in a crowded indoor space, think very carefully about your exposure to COVID and try to see if you can wear a mask, if at all possible.”